Residual vein obstruction in patients diagnosed with acute isolated distal deep vein thrombosis associated with active cancer
After acute proximal deep vein thrombosis (DVT) the thrombotic mass decreases, especially during the first months of anticoagulation. The persistence of residual vein obstruction (RVO) may predict future recurrence in patients with cancer-associated DVT. We aimed to evaluate the proportion of patients with RVO after an episode of cancer associated isolated distal DVT (IDDVT), to identify variables associated with RVO, and to provide initial evidence of its association with recurrent VTE. We performed a post-hoc analysis of a multicenter cohort study of patients with isolated cancer-associated acute IDDVT. We included patients who underwent a control ultrasonography at the end of the anticoagulant treatment between day 30 and day 365 after index IDDVT, given that no recurrent VTE had already occurred on anticoagulant treatment. A total of 153 patients had ultrasonographic follow-up after a median of 92 days from index IDDVT: 45.8% had RVO and 54.2% exhibited complete recanalization. Female sex, Body Mass Index > 30 Kg/m2 and involvement of axial calf veins showed the strongest association with RVO. The risk of recurrence was twofold higher in patients with (versus without) RVO. RVO persisted in approximately half of patients with an episode of cancer-associated IDDVT at anticoagulant discontinuation. Patients with RVO appeared to be at a higher risk for recurrent events.
KeywordsDistal deep vein thrombosis Residual vein obstruction Compression ultrasound Venous thromboembolism Recurrence
The patients included in this study were followed at 12 Italian centers (Varese, Naples, Avezzano, Cuneo, Rozzano, Bologna, Udine, Livorno, Palermo, Milan, Piacenza, Chieti). The present study was not funded.The work of Stefano Barco is supported by the German Federal Ministry of Education and Research (BMBF 01EO1003 and 01EO1503).
FD and MDN were responsible for the concept and design of the study. FD, MDN, SP, MNDDM, DM, FP, CL, FB, MS, GB, NM, MN, SMP, RB, and WA were responsible for acquisition of data. FD, SB, NM, MDN, MNDDM, and WA were responsible for database handling and updating. SB was responsible for statistical analysis. SB, FD, and MDN were responsible for drafting the manuscript and for interpretation of results. All authors had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis, and provided final approval.
Compliance with ethical standards
Conflict of interest
The corresponding author states that there are no potential conflicts of interest to disclose.
This research study has been performed according to the general principles of the Declaration of Helsinki (General Assembly, Helsinki, Finland, June 1964), on ethical principles for medical research involving human subjects.
Informed consent to use their medical information was obtained by all patients included in the study at the time of DVT diagnosis.
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